We are Seattle journalists who made a documentary about a man’s choice to end his life using Washington’s Death with Dignity law. Ask Us Anything

What method did Bob choose to die? And do you believe it was painless?

Bob took a four medication compounded mixture which we mixed with Kahlua and he took it using his feeding tube. He felt nothing, other than sleepiness. – Stephanie

How do we know for sure that someone isn't feeling pain when they take a drug cocktail like this? Is it possible that they are feeling pain even though they aren't showing physical signs of it?

They might be feeling pain from the underlying illness and life ending meds don't have anything in them that would cause pain. -Stephanie

Hi, and thanks for doing this AMA. Two questions for you:

1) What is the approximate cost of the process for a patient who takes this action? I am guessing this is not covered by insurance...

2) Is there any data on the utilization rates of this program yet? By that I mean do we know how common participation among terminal patients in the state is? Is this a difficult service to access due to physicians being reluctant or organizations being unwilling to let their doctors participate?

1. Technically, there’re two protocols we use. Seconal which is incredibly difficult to get and costs about $3000. The protocol Bob used was the compounded mixture which costs about $800. SOME insurance covers it and we encourage client’s families to submit the expense to their insurance company in case it’s covered. Also possibly, if enough insurance companies are requested to cover it, their polices might change.
2. I think it is more a matter of lack of knowledge about the law. I believe utilization rates are less than 5 percent if I recall correctly. If we had more people asking their physicians I think more would be supportive.

-Stephanie

Also possibly, if enough insurance companies are requested to cover it, their polices might change.

You'd think insurance companies would be willing and eager to end the lives of expensive patients. How would requests from patients make a difference?

My thought is if enough people ask for something to be covered, it might start being covered. Stephanie

What would you most like to tell us that no one asks about?

People want to know about the last day and we've received a lot of questions about that. But it's the first day that sticks in my mind. How positive he was. How funny. How full of life and how resolved he was with his plan. That first day with Bob opened my eyes. From day 1 he had this ability to make US feel comfortable with his decision.- John

Did you come in with a preconceived idea that was changed or wavered by the end of your experience with Bob? If so, would you share?

I knew very little about the ‘Death with Dignity’ law before taking on this project so I went in with a blank slate. Once it was all said and done, I understand why people like Bob would want to use ‘Death with Dignity’. -Joseph

You can back out at any point right?

Correct. -Joseph.

Is there criteria for what conditions are deemed as suffering when it comes to choosing to finish life?

Is counseling required for patients considering assisted suicide? If so, for how long?

Can people choose to die in their homes or another setting, or does this only happen in a hospital?

So many people want more information about this, but the taboo seems to interfere with even the statistics. How can we reduce the stigma surrounding choosing when we die?

The requirements are 1) WA resident 2) Of sound mind 3) Terminal diagnosis with less than six months to live 4) being able to self-ingest. Counseling isn’t actually required. Folks can take their meds in their home just not in a public place. - Stephanie

When you say of sound mind, does that mean a person with a mental illness such as bipolar would not be eligible?

The prescribing physician determines competence. People with dementia are not eligible. -Stephanie

Is it possible to do an advanced directive that states that in the future if you meet the other criteria but are no longer of sound mind, you would still like pursue this path?

at the time someone takes the meds, they have to be of sound mind. - Stephanie

What are the consequences if they do take it in, say, a park?

The person takes the meds and is asleep within 10 minutes. The actual death can take as short as four minutes or as long as 27 hours with an average of about two hours. Normally someone is on hospice when he/she takes the meds. After the death, we call hospice and they contact the funeral home. Stephanie

So at the end of the documentary, where it shows Bob lying on the bed with his eyes closed after he had taken the meds and the camera pans to the angel pictures, then out the window...how long after he had taken the meds was that? Do you know if he was “sleeping” (in the process of dying) or was he actually deceased at that point?

That shot was taken around 4 minutes after he took his medication. He passed four hours and thirty-four minutes later. -Joseph

Any strange sounds or movements?

No. The only sound you could hear were from his loved ones that surrounded his death bed singing "Amazing Grace" as he passed. -Joseph

Is there a time window on the residency clause? Can people start moving to Washington if they feel this path is right for them?

yes they can move here to take advantage of the law - Stephanie

Pardon me if this is in the documentary, but I haven’t had time to watch yet.

How is “self-ingest’ defined when using a feeding tube? Bob had to pour it in himself?

I put the meds in the syringe and he had to depress the plunger - Stephanie

When dealing with the general public, Do you find most people support this or are they opposed?

Almost all of the people in Bob's circle were very supportive of his decision. Bob knew he would have his critics and he would say 'It's not for everybody. But this was my choice.'

What about others who from the general public who know of the story? I guess I’m wondering how people are responding outside his close support group.

I'd say 95% of the people who view the documentary are supportive - Stephanie

For the general public we see about 80 - 85% support.

Of all of the reasons argued against assisted suicide, which one do you feel is the most valid?

For the record, I am fully supportive of peoples right to die with dignity.

We call it Aid in Dying or Death with Dignity. The death certificate shows he/she died of their underlying illness. Regarding the reason against it......I would say - if your values say it's a sin - Stephanie

How does this work in regards to life insurance? Does this keep his family from receiving any money from insurance to pay for his funeral, burial, etc?

The death certificate shows the person died of the underlying illness so his/her death is no different from any other death from that perspective - Stephanie

I haven't seen the documentary, but I am curious about it. What was the hardest part of filming?

The day Bob died was very tough mentally and emotionally.

When Bob went into his bedroom to change into his pajamas, I waited outside of his room with loved his loved ones and cried. I kept thinking to myself “what am I doing? Why am I doing this?” I knew this is what Bob wanted. Bob specifically reached out to John and I to share his story. That gave me the strength to continue with the shoot.

-Joseph

Does age matter? Could a 20 year old who was given less than 6 months to live apply?

Side note: I wish this existed in Poland when my grandfather was diagnosed with cancer. He was a big strong WW2 veteran and the illness stripped away all his dignity before he passed away :(

In WA the requirements are 1) WA resident 2) Of sound mind 3) Terminal diagnosis with less than six months to live 4) being able to self-ingest. A 20 year old is an adult so would be eligible. - Stephanie

I worked a 25 year career in organ donation particularly in organ procurement and was involved in putting Oregon's Death with Dignity's act together... I was wondering if you had the same experience with pharmacists refusing to fill scripts for this protocol? How about any pushback from the Catholic Health Groups?

Yes, there is pushback there. And even if the policy of the pharmacy is to support, the Pharmacist himself/herself can choose not to fill the script - Stephanie

Did you get any blowback from Bobs loved ones? Did they handle his decision well?

Thank you so much for the work you do.

Thank you. To the question of blowback. Not at all. Bob's loved ones, and I include friends, ultimately were very supportive and didn't want to see him suffer. - John

My family has a history of Demetia, all die around 71, I am currently taking care of my uncle who has it, It's a difficult disease, he believes in being able to die with dignity, but didn't set it up before the Demetia took over. I would like to set something up for myself. If I get this disease I do not want my family to have to suffer with me, Is there a way to set this up in a end of life plan??

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level 1Baphom3t871 point · 6 minutes agoAre there any plans to go over seas and see how death of dignity law is being used and different routes?

yes, you can create an Advance Directive to document your wishes and designate someone as your healthcare power of attorney - Stephanie

Did you learn anything about Bob that was particularly surprising?

I was surprised he never wavered about his decision. I made a point of asking him each time I saw him if he was still sure. Each time, he was. 'Till the end.- John

When dealing with the general public, Do you find most people support this or are they opposed?

he was in so much pain, I was surprised he lasted until May 10. That said he had such a huge party planned he really wanted to hold out. Stephanie

Interesting. I was curious how long he'd have lived if he hadn't taken this course. Sounds like not that much longer.

He was expected to die over the summer months. -Joseph

What did you find is most misunderstood about this law/issue?

I think a lot of people don't even know it's an option in Washington state. It's one of the reasons Bob wanted to share his story. He wanted people to know Death with Dignity was an option. And his choice. - John

The wa.gov link says they can request medication. Reddit’s favorite painless death method is nitrogen hypoxia. Would that be allowed or does it have to be pharmaceutical?

In Washington State, we have two prescription protocols and I think most doctors would prescribe the pharmaceutical - Stephanie

Are medical professionals required to present dying with dignity as an option to a terminally ill patient?

I would guess the answer is “no”. If so, do we have any idea of what percentage of terminally ill patients are informed of this choice? And what percentage of those elect it?

Are medical professionals required to present dying with dignity as an option to a terminally ill patient?

I would guess the answer is “no”. If so, do we have any idea of what percentage of terminally ill patients are informed of this choice? And what percentage of those elect it?

Medical professionals (or hospice) are not required to educate their patients about this option. Would love to see that change! - Stephanie

He chose May because he didn't think he'd make it through the summer. He was in a ton of pain and his airways could well have started restricting. - Stephanie

Is there a resource to find other states that do this?

Yes, you can find more information about Death with Dignity laws here: https://www.deathwithdignity.org/ Currently eight states and the District of Columbia have Death with Dignity laws.

At any point during the filming did you not want Bob to go through with it?

Throughout the filming we kept asking the question, 'Are you still good with this?. He never wavered and wanted us to know he wanted to take control of his end of life. Our commitment was to be there with him 'till the end but we knew that at any moment he could change his mind. That was another question I kept asking 'Have you considered changing your mind?' 'Never' was his response. Of course we were prepared for a change of heart, prepared to tell THAT story. - John

Hi there,

I am about to graduate as a journalism major from college. This is an incredible story, but I cannot imagine how difficult it was for y’all emotionally at times which leads me to my questions.

What resources were made available to y’all during this story in regards to y’all’s mental health, and what resources did you end up using?

Thank you

My management was great during the process of filming/editing this documentary. They allowed me to take time off whenever I felt like I needed a break. -Joseph

That’s so wonderful to hear!! I’m very glad you were able to prioritize your mental health while also telling this story.

Were there any coping mechanisms that helped you the most?

I'm still in the process of figuring it out with counseling. I have very supportive friends and family that have been there through the whole process. I have time off coming up to help reset my mind.-Joseph

I've been watching a ton of death with dignity documentaries the past couple of months (not planning on doing it, was just super interested about it) and I've surmised that there are two common ways of ending one's life: drinking pentobarbital mixed with a liquid and through an injection. Are there any other ways that have been approved? Is there like a movement of sorts to add (or take away) methods of death with dignity?

In WA , technically, there’re two prescription protocols we use that people drink or put in a feeding tube: Seconal which is incredibly hard to get and costs about $3000. The protocol Bob used was the compounded mixture which costs about $800. Injection is not part of the WA DWD act

How did you get the funding ?

This was a KING 5 project. We had the support from our management and company. -Joseph

You touched on this a bit on the FB group but what was it like for you mentally to shoot the thing Jojo?

The day Bob died was very tough mentally and emotionally.

When Bob went into his bedroom to change into his pajamas, I waited outside of his room with loved his loved ones and cried. I kept thinking to myself “what am I doing? Why am I doing this?” I knew this is what Bob wanted. Bob specifically reached out to John and I to share his story. That gave me the strength to continue with the shoot.

Editing the documentary very exhausting mentally, emotionally and physically, I had to take breaks. Sometimes I’d take weeks off from editing to clear my mind. - Joseph

I would also like to mention that I was really nervous going into this project. I wasn't sure what was going to happen or the emotions I would feel the day of.- Joseph

Why are you smiling?

Only kidding... I am thankful for the new euthanasia laws and hope they spread nationwide.

But on a serious note, please describe the myriad of emotions that you experienced as a documentarian witnessing an event like this, and how you coped.

Yes, you're right. There were a myriad of emotions culminating in that last day. We were sobbing at the end, but I kept in mind that this was his choice and his right to make that choice. Bob was a great man who had an impact on many people. In the documentary we mentioned he sponsored about 100 people through AA. Bob was beloved. - John

Are there any plans to go over seas and see how death of dignity law is being used and different routes?

Also any other documentaries on the horizon since this one was so well recieved from the public?

I’d like to take some time for myself before taking on another big project.- Joseph

In your time with Bob, did you ever ever ever get even the slightest feeling of doubt with his decision? And I mean at all.

Not at all. He was at peace with his decision the entire time we were with him. However, in the middle of shooting, Bob got sick and was worried that he wouldn't be able to make it to May 10th... His 'death date'. - Joseph

What was the most surprising part about the process? Did your attitude towards life/death change as a result of doing this project?

It was amazing to see the love and care that was happening during Bob’s celebration of life party. It made me appreciate the importance of having loved ones with you at the end of your life. -Joseph

What were Bob's last words?

I just went back and watched the raw to answer this.

There were about 50 people in the room and he started to thank people individually. He was only able to get three people before he fell asleep. -Joseph

2 questions: Is there a statistic that keeps track of how many WA residents have utilized this Death w/ Dignity Law?

Would you be supportive of having less requirements to end your own life. Such as being without a terminal illness?

report

Washington's Department of Health keeps tracks of how many people have used the Death with Dignity law. Last year 267 people received medication under the law. Since the law went into effect 10 years ago, over 1,600 people have received medication in Washington state. You can read the 2018 report here: https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2018.pdf